performed when: Claim edits and denials are researched and discrepancies resolved within 2 days of notification...
for keying patient information into internal information system. Analyzes, works, and appeals denials from EOB.... Participates in special projects and/or assignments as requested by Manager /Director. Resolve insurance claim denials...
claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly... in a system work queue. Accurately handle claim adjustments and coverage changes as needed. Review and process claim denials...
utilizing our EPM system - Nextgen to determine appropriate action. Review explanations of benefits details on denials...
. Respond as able to in basket messages regarding the process and results. Schedule peer to peer calls, manage denials, handle...
for all prices; Print Medicaid for audits with corrections and claims submissions printout. Review denials; Resubmitting...
guidelines. This includes: high-level data analysis, detailed research of complex denials, reporting for trended claim issues...
, or denials for correction for submission or resubmission to patients and/or insurance carriers. Accurately perform actions...
patterns leading to denials. Regularly review and refine processes to ensure continuous optimization and adherence...
records, daily batches, denials, account analysis, and performing other duties as required or assigned. Requirements...
, and obtain insurance authorizations. Monitor provider open charts, work on denials, and secure complex authorizations...
policies and procedures as needed to coincide with government regulations. Responsible for processing Coding Claim Denials...
activities in an attempt to prevent insurer denials, enhance revenue, and to recover payment for services that have been denied... denials. Follows departmental policy to communicate internally with physicians, care coordination, utilization nurses. 4...
claim issues. Researches and reworks all claim kickbacks, rejections, and denials. Review medical records to ensure orders...
inpatient denials. Performs retroactive reviews on discharged patients as assigned. Communicates any necessary information... to payers to help appeal existing denials. Uses level of care criteria to justify the patient's severity of illness...
to proper specialist, preparing paperwork, obtaining authorization from insurance company and handling denials and problems...
Triage, troubleshoot and resolve initial and ongoing reimbursement issues (PAs, denials, appeals, reauthorizations, overrides...
wide clinical revenue management activities in an attempt to prevent insurer denials, enhance revenue, and to recover... and/or peer to peer reviews for concurrent denials. Follows departmental policy to communicate internally with physicians, care...
, denials, and processing appeals as needed. Responsibilities: Reviews clinical note, x-rays, and account ledger for cohesion... and completes all appeals and requests from insurance companies Reviewing returned EOBs: o Denials- manages info...
various denials from insurances including coverage in question, medical necessity, bundling, non-covered procedures, incorrect...